Brachytherapy
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Brachytherapy

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  • Picture and text with reflection(Basic)To reproduce the picture effects on this slide, do the following:On the Home tab, in the Slides group, click Layout and then click Blank. On the Insert tab, in the Illustrations group, click Picture. In the Insert Picture dialog box, select a picture, and then click Insert. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 3.17” and the Width box is set to 10”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes. Select the picture. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide. Click Align Top.Under Picture Tools, on the Format tab, in the Picture Styles group, click Picture Effects, point to Reflections, and then under Reflection Variations click Half Reflection, touching (first row, second option from the left). On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Impact from the Font list and then enter 42 in the Font Size box.On the Home tab, in the Paragraph group, click Align Text Right to align the text right in the text box.Select the text box. Under Drawing Tools, on the Format tab, in the WordArt Styles group, click Text Effects, point to Reflection, and then under Reflection Variations click Half Reflection, touching (first row, second option from the left). Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click Text Fill in the left pane, select Solid fill in the Text Fill pane, and then do the following:Click the button next to Color, and then under Theme Colors, click White, Background 1 (first row, first option from the left). In the Transparency box, enter 12%.On the slide, drag the text box onto the picture to position as needed. To reproduce the background on this slide, do the following: Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).In the Angle box, enter 0⁰.Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 10%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 5% (second row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 99%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 35% (fifth row, first option from the left).
  • Custom animation effects: shrink picture circle with text(Intermediate)To reproduce the picture effects on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.On the Insert tab, in the Illustrations group, click Picture. In the InsertPicture dialog box, select a picture, and then click Insert.On the slide, select the picture. Under PictureTools, on the Format tab, in the PictureStyles group, click PictureShape, and then under BasicShapes click Oval (first row, first option from the left).Select the picture-filled oval. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 6” and the Width box is set to 6”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes. Under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, and then under GlowVariations click Accent color 1, 18 pt glow (fourth row, first option from the left).Under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, point to More Glow Colors, and then under ThemeColors click White, Background 1 (first row, first option from the left).On the Home tab, in the Drawing group, click the Format Shape dialog box launcher. In the Format Picture dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets, under Inner click InsideDiagonalBottomLeft (third row, first option from the left), and then do the following:In the Transparency box, enter 50%.In the Blur box, enter 8 pt.In the Angle box, enter 135°.In the Distance box, enter 8 pt.On the Insert tab, in the Text group, click TextBox. On the slide, drag to draw a text box.Enter text, and then select the text. On the Home tab, in the Font group, do the following:In the Font list, select Candara.In the FontSize box, enter 30.Click the arrow next to FontColor, and then click Black, Text 1, Lighter 25% (fourth row, second option from the left).On the Home tab, in the Paragraph group, click AlignTextLeft.On the slide, select the text box. Under DrawingTools, on the Format tab, in the WordArt Styles group, click TextEffects, point to Reflection, and then under ReflectionVariations click TightReflection, touching (first row, first option from the left).Drag the text box onto the right half of the slide.With the text box still selected, on the Home tab, in the Drawing group, click Arrange, and then do the following:Point to Align, and then click Align to Slide.Point to Align, and then click Align Right.Point to Align, and then click Align Middle.Click Send to Back. To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Basic, click Wheel.Select the animation effect (wheel effect for the picture). Under Modify: Wheel,do the following:In the Start list, select WithPrevious.In the Spokes list, select 1 Spoke.In the Speed list, select Medium. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, click FadedZoom.Select the second animation effect (faded zoom effect for the picture). Under Modify: FadedZoom,do the following:In the Start list, select WithPrevious.In the Speed list, select Medium. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Grow/Shrink.Select the third animation effect (grow/shrink effect for the picture). Click the arrow to the right of the selected effect, and then click EffectOptions. In the Grow/Shrink dialog box, do the following:On the Effect tab, under Settings, do the following:In the Size list, in the Custom box, enter 95%, and then press ENTER.Select SmoothStart.Select SmoothEnd.Select Auto-reverse.On the Timing tab, do the following: In the Start list, select AfterPrevious. In the Speed box, enter 0.3 seconds. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Grow/Shrink.Select the fourth animation effect (grow/shrink effect for the picture). Under Grow/Shrink, do the following:In the Start list, select AfterPrevious.In the Size list, select Smaller.In the Speed list, select Medium. On the slide, select the picture. In CustomAnimation task pane, do the following:ClickAddEffect, point to MotionPaths, and then click Left.Select the fifth animation effect (left motion path for the picture). Under Modify: Left,do the following:In the Start list, select WithPrevious.In the Speed list, select Medium.On the slide, select the text box. In the CustomAnimation task pane, do the following:Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, select Fade.Select the sixth animation effect (fade effect for the text box). Click the arrow to the right of the selected effect, and then click Timing. In the Fade dialog box, on the Timing tab, do the following:In the Start list, select WithPrevious.In the Delay box, enter 1.5.In the Speed list, select 1 seconds (Fast).On the slide, select the text box. In CustomAnimation task pane, do the following:ClickAddEffect, point to MotionPaths, and then click Left.Select the seventh animation effect (left motion path for the text box). Under Modify: Left,do the following:In the Start list, select WithPrevious.In the Speed list, select Fast.On the slide, right–click the selected motion path for the text box, and then clickReversePathDirection. To reproduce the rectangle on this slide, do the following: On the Home tab, in theDrawing group, clickShapes, and then under Rectangles click Rectangle (first option from the left). On the slide, drag to draw a rectangle.Select the rectangle.Under DrawingTools, on the Format tab, in the Size group, do the following:In the ShapeHeight box, enter 1.54”.In theShapeWidth box, enter 10”.Under DrawingTools, on theFormat tab, in the ShapeStyles group, click the arrow next to ShapeOutline, and then click NoOutline.Under DrawingTools, on the Format tab, in the bottom right corner of the ShapeStyles group, click the FormatShape dialog box launcher. In the Format Shape dialog box, clickFill in the left pane, selectGradientfill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Right (first row, fourth option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).In the Transparency box, enter 88%.Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).In the Transparency box, enter 43%.On the Home tab, in the Drawinggroup, click Arrange, and then do the following:Point to Align, and then click Align to Slide. Point to Align, and then clickAlignMiddle.Point to Align, and then clickAlignCenter.Click Send to Back. To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 50% (second row, second option from the left).
  • Custom animation effects: title fade-in on path and text fade by letter(Intermediate)Tip: For the effects on this slide, use a picture that measures 7.5” high (the height of the slide) and 2.61” wide.To reproduce the shape effects on this slide, do the following:On the Home tab, in theDrawing group, clickShapes, and then under Rectangles click Rectangle (first option from the left). On the slide, drag to draw a rectangle.Select the rectangle. Under DrawingTools, on the Format tab, in the Size group, do the following: In the ShapeHeight box, enter 3.17”.In the ShapeWidth box, enter 9.5”.Drag the rectangle slightly above the middle of the slide. Select the rectangle. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Left.Under DrawingTools, on theFormat tab, in the ShapeStyles group, click the next to ShapeOutline, and then click NoOutline.Under DrawingTools, on the Format tab, in the bottom right corner of the ShapeStyles group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Right (first row, fourth option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 50% (fifth row, 10th option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 25% (fourth row, 10th option from the left).To reproduce the “heading” text box on this slide, do the following:On the Insert tab, in the Text group, select TextBox. On the slide, drag to draw a text box.Enter the heading text, and then select text. On the Home tab, in the Font group, do the following:In the Font list, select Calibri.In the FontSize box, enter 38.Click Bold.Click the arrow next to FontColor, and then under ThemeColors click Orange, Accent 6, Darker 25% (fourth row, 10th option from the left).On the Home tab, in the Paragraph group, click AlignTextLeft.Drag the text box just above the rectangle, in the right half of the slide. To reproduce the second text box on this slide, do the following:On the Insert tab, in the Text group, click TextBox. On the slide, drag to draw a text box.Enter three lines of text with paragraph breaks, and then select the text. On the Home tab, in the Font group, do the following:In the Font list, select Calibri.In the FontSize list, select 28.Click Bold.Click the arrow next to FontColor, and then under ThemeColors click White, Background 1 (first row, first option from the left).On the Home tab, in the Paragraph group, click AlignTextLeft.Drag the second text box onto the rectangle, below the “heading” text box. To reproduce the full-color picture on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.On the Insert tab, in the Illustrations group, clickPicture. In the InsertPicture dialog box, select the 7.5” x 2.61” picture, and then click Insert.On the slide, select the picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, under Crop from,in the Bottom box, enter 2.43”. (Note: Under Size and rotate, the Height should now be 5.08”.)On the slide, select the picture. UnderPicture Tools, on the Format tab, in the Picture Styles group, click Picture Effects, point to Glow, and then under Glow Variations click Accent color 1, 5 pt glow (first row, first option from the left).Also under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, point to MoreGlowColors, and then under ThemeColors click White, Background 1 (first row, first option from the left).Drag the full-color picture on top of the rectangle, to the left of the text boxes. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Top. To reproduce the second picture on this slide, do the following:On the Insert tab, in the Illustrations group, click Picture. In the InsertPicture dialog box, select the same 7.5” x 2.61” picture, and then click Insert. On the slide, select the picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, under Crop from,in the Top box, enter 5.08”. (Note: Under Size and rotate, the Height should now be 2.43”.)On the slide, select the second, smaller picture. Under PictureTools, on the Format tab, in the PictureStyles group, click the FormatShape dialog box launcher. In the FormatPicture dialog box, click Picture in the left pane, and in the Picture pane do the following:In the Brightness box, enter 70%.In the Contrast box, enter -70%.On the slide, drag the smaller picture until it is directly underneath the larger full-color picture.Select the smaller picture. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Bottom. Press and hold CTRL, and then select both pictures. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align Selected Objects.Click Align Center. To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation. On the slide, select the “heading” text box. In the CustomAnimation task pane, do the following:Click AddEffect, point to Entrance, and then click MoreEffects. In the AddEntranceEffect dialog box, under Subtle, click Fade.Select the animation effect (fade effect for the “heading” text box). Click the arrow to the right of the selected text box, and then click Timing. In the Fade dialog box, on the Timing tab, do the following:In the Start list, select WithPrevious.In the Delay box, enter 1.5.In the Speed list, select 2 seconds (Medium).On the slide, select the “heading” text box. In the CustomAnimation task pane, do the following:ClickAddEffect, point to MotionPaths, and then click Left.Select the second animation effect (left motion path for the “heading” text box). Under Modify: Left,do the following:In the Start list, select WithPrevious.In the Speed list, select Medium. On the slide, right-click the left motion path and click ReversePathDirection. With the motion path still selected,point to the starting point (green arrow) of the motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT, and then drag the starting pointabout 1.5” off the left edge of the slide. (Note: It may help to display the ruler. On the View tab, in the Show/Hide group, select Ruler. If your lines of text are longer than in the example above, you may need to further increase the length of the motion path. )On the slide, select the second text box. In the CustomAnimation task pane, do the following:Click AddEffect, point to Entrance, and then click MoreEffects. In the AddEntranceEffect dialog box, under Subtle, click Fade.Select the third animation effect (fade effect for the second text box). Click the arrow to the right of the selected effect, and then click Effect Options. In the Fade dialog box, do the following:On the Effect tab, do the following:In the Animate text list, select By Letter.In the % delay between letters box, enter 5.On the Timing tab, do the following:In the Start list, select AfterPrevious.In the Speed list, select 0.5 seconds (VeryFast).On the TextAnimation tab, in the Grouptext list, select By 1st Level Paragraphs.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until three stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 40%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 3 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 232, Green: 227, and Blue: 216.
  • Custom animation effects: spinning clip art with text(Intermediate)To reproduce the clip art on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.On the Insert tab, in the Illustrations group, click Clip Art.In the Clip Art pane, in the Search for box, enter j0435540. In the Search in list, select Everywhere, and then click Go. Select the clip art file in the pane to insert it into the slide. (Note: If you choose another clip art file, the clip art must be in the Windows Metafile format [.wmf].)On the slide, select the clip art. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 5.83”.In the Shape Width box, enter 8.12”.On the Home tab, in the Drawing group, click Arrange, and then click Ungroup.In the Microsoft Office PowerPoint dialog box, click Yes. On the slide, select the converted clip art. On the Home tab, in the Editing group, click Select, and then click Selection Pane. In the Selection and Visibility pane, select the top-level group. On the Home tab, in the Drawing group, click Arrange, and then click Ungroup. Also in the Selection and Visibility pane, select the Autoshape object, and then press DELETE. Press CTRL+A to select all of the objects on the slide. On the Home tab, in the Drawing group, click Arrange, and then click Group.Select the group. On the Home tab, in the Drawing group, click Shape Effects, point to Preset, and then under Presets click Preset 8 (second row, fourth option from the left). With the group still selected, under DrawingTools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher, and do the following:On the Size tab, in the Height box, enter 6.27”.On the Size tab, in the Width box, enter 6.27”.On the Position tab, in the Horizontal box, enter 3.89”. On the Position tab, in the Vertical box, enter 1.55”To reproduce the text on this slide, do the following:On the Insert tab, in the Text group, click TextBox.Drag to draw a text box on the slide.In the text box, enter text and select it. On the Home tab, in the Font group do the following:In the Font list, select Candara.In the FontSize box, enter 32 pt.In the FontColor list, under StandardColors select Orange (third option from the left). Click Italic. Select the text box on the slide, and then under DrawingTools, on the Format tab, in the Size group, do the following:In the ShapeHeight box, enter 7.29”.In the ShapeWidth box, enter 7.29”.Under DrawingTools, on the Format tab, in the WordArtStyles group, click TextEffects, point to Transform, and under FollowPath select ArchUp (first option from the left).To wrap the text upside down, at the bottom of the text box, drag the pink adjustment diamond from the center left position in the text box to the lower right corner of the text box. With the text box still selected, under DrawingTools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher, and then on the Position tab do the following:In the Horizontal box, enter 3.38”. In the Vertical box, enter 1.04”.To reproduce the animation effects on this slide, do the following:On the Animation tab, in the Animations group, click CustomAnimation.Select the circle clip art on the slide, and then in the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis effect and select MoreEffects. In the AddEmphasisEffect dialog box, under Basic select Spin, and then click OK.Click the arrow to the right of the spin emphasis effect, select Effect Options,and do the following:On the Effect tab, under Settings, in the Amount list, select QuarterSpin.On the Effect tab, under Settings, in the Amount list, select Counterclockwise.On the Timing tab, in the Start list, select WithPrevious.On the Timing tab, in the Speed box enter4.0 seconds.Click OK.On the slide, select the text box, and then in the CustomAnimation task pane, do the following:Click the AddEffect, point to Entrance and select MoreEffects. In the AddEntranceEffect dialog box, under Subtle select Fade, and then click OK.Select the fade entrance effect (second effect), and under Modify: Fade do the following:In the Start list, select WithPrevious.In the Speed list, select Slow. With the text box still selected, click AddEffect, point to Emphasis and select MoreEffects. In the AddEmphasisEffect dialog box, under Basic select Spin, and then click OK.Select the spin emphasis effect (third effect), and under Modify: Spin do the following:In the Start list, select WithPrevious.In the Amount list, select HalfSpin.In the Speed list select Slow. With the text box still selected, click AddEffect, point to Emphasis and select MoreEffects. In the AddEmphasisEffect dialog box, under Basic select Spin, and then click OK.Click the arrow to the right of the spin emphasis effect (fourth effect), select Effect Options,and do the following:On the Effect tab, under Settings, in the Amount list, in the Custom box enter 30°, and then press ENTER.On the Effect tab, under Settings, in the Amount list, select Counterclockwise.On the Timing tab, in the Start list, select WithPrevious.On the Timing tab, in the Delay box enter 3.0 seconds.On the Timing tab, in the Speed box enter1 seconds (Fast).Click OK.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.In the Direction, list click Linear Down (first row, second option from the left)Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors clickBlack, Text 1, Lighter 50% (second row, second option from the left).

Brachytherapy Presentation Transcript

  • 1. Two major categories for the application of radiation for cancer treatment are externalbeam therapy and brachytherapy. For external-beam treatment, the patient lies underneath a machine that emits radiation or generates a beam of x-rays. This tech-nique is also called teletherapy, or long- distance treatment. Most cancer patients are treated in this fashion. However, some pa-tients may also be treated with brachyther-apy.
  • 2. What is Brachytherapy?
  • 3. • from the Greek word βραχυς brachys, meaning "shortdistance“. • Also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy.
  • 4. •A type of radiation therapy used to treat cancer, involving the placement of a radioactive material, either temporarily or permanently, directly inside the body.
  • 5. • Unlike EBRT which delivers an external radiation source through healthy tissue (‘from the outside, in’), brachytherapy delivers the radioactive dose directly within or adjacent to the tumor (‘from the inside, out’).
  • 6. Brachytherapy works ‘from the inside, out’ External beam radiotherapy (EBRT) works ‘from the outside, in’
  • 7. • The theory behind brachytherapy is to deliver low-intensity radiation over an extended period to a relatively small volume of tissue. • The low intensity isotopes are placed directly into a tissue or cavity depositing radiation only a short distance, covering the tumor area but sparing surrounding normal tissue.
  • 8. • This technique allows a higher total dose of radiation to be delivered to the tumor than is achievable with external beam radiation alone.
  • 9. A brief timeline
  • 10. 1896 Discovery of radioactivity Henri Becquerel, a French physicist, accidentally discovered radioactivity. He noticed that Uranium caused a black spot to appear on a photographic plate that had not been exposed to sunlight. This discovery raised interest into the effects of radiation, which would later lead to the first use of Brachytherapy Henri Becquerel
  • 11. 1901 First use of Brachytherapy Pierre Curie (a French physicist who studied the effects of radioactivity) suggested to Henri-Alexander Danlos (a French doctor) that radioactivity could be use to treat cancer. Danlos tested the idea and found that radiation caused cancer tumors to shrink. Early techniques of brachytherapy were pioneered at the Curie Institute in Paris by Danlos and at St. Luke’s and Memorial Hospital in New York by a surgeon called Robert Abbe. P i e r re Cu r i e
  • 12. 1903-1950 Early pioneers In the years after the first use of brachytherapy, a number of doctors pioneered the application of it to treat different types of cancer. These included Margaret Cleaves in the field of cervical cancer, Hugh Hampton Young and Benjamin Barringer in the field of prostate cancer and Geoffrey Keynes in the field of breast cancer. Margaret Cleaves
  • 13. 1970 Enhanced radiation safety One of the early challenges of brachytherapy is ensuring the healthcare professionals delivering treatment were not exposed to radiation on a daily basis. By 1970’s, special machine known as ‘afterloaders’ were made available. Afterloaders contain the radiation sources used for high dose rate brachytherapy. Staff can remotely control the ‘afterloader’ from a separate observation room to deliver the radiation from the machine into the patient’s body. A modern afterloader machine
  • 14. 1990 Advanced Imaging techniques In the 1990s, various imaging technologies, such as ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT) scans become more widely available. These technologies help doctors plan the brachytherapy procedures. They can also be used during the brachytherapy procedure to ensure the radiation is precisely delivered to exactly the right place. Ultrasound image of the prostate
  • 15. 2000 Virtual treatment planning introduced At the turn of the new century, advanced computerized brachytherapy planning systems were introduced. These enable healthcare professionals to accurately plan the delivery of the radiation using a virtual 3D representation of the patient. Doctors can then precisely target the radiation to the cancerous tumor and avoid damage to the healthy surrounding tissues. Creation of a 3D ‘virtual’ patient
  • 16. 2005 Robotic delivery of Prostate seed therapy The first robotic device to accurately deliver brachytherapy for prostate cancer (seed therapy) was introduced. Technological innovations such as this have helped to make brachytherapy even more effective and safe. Robotic delivery of seed therapy
  • 17. CLINICAL APPLICATIONS • Brachytherapy can be used in combination with other therapies such as surgery, EBRT or chemotherapy, particularly when the tumor is too large or is not easily accessible. • Brachytherapy has been most widely applied in the treatment of :     Cervical Prostate Breast and skin cancers Brachytherapy can also be used to treat tumors in several other body sites.
  • 18. Body sites in which brachytherapy can be used to treat cancer
  • 19. Brachytherapy can be characterized according to three main factors: • Source placement • Treatment duration & • Dose rate
  • 20. ACCORDING TO SOURCE PLACEMENT • Interstitial - the sources are placed directly in the target tissue of the affected site, such as the prostate or breast. • Contact - involves placement of the radiation source in a space next to the target tissue. • • • • Intracavitary – A body cavity such as cervix, uterus or vagina. Intraluminal – A body lumen such as the trachea or esophagus. Surface (Mould) – externally such as the skin. Intravascular – Blood vessels.
  • 21. ACCORDING TO TREATMENT DURATION • Temporary- Dose is delivered over a short period of time and the sources are removed after the prescribed dose has been reached. The specific treatment duration will depend on many different factors, including the required rate of dose delivery and the type, size and location of the cancer. • Permanent- also known as seed implantation, involves placing small LDR radioactive seeds or pellets (about the size of a grain of rice) in the tumour or treatment site and leaving them there permanently to gradually decay.
  • 22. ACCORDING TO DOSE RATE • Low-dose rate(LDR)- Emit radiation at a rate of 0.4– 2 Gy/hour. Commonly used for cancers of the oral cavity, oropharynx, sarcomas and prostate cancer • Medium-dose rate (MDR)- characterized by a medium rate of dose delivery, ranging between 2-12 Gy/hour. • High-dose rate (HDR)-when the rate of dose delivery exceeds 12 Gy/h. • Pulsed-dose rate (PDR) - involves short pulses of radiation, typically once an hour, to simulate the overall rate and effectiveness of LDR treatment.
  • 23. Characteristic Source Placement Type Description Clinical example(s) Source placed next to the tumor Cervix, trachea, skin Permanent Source implanted permanently Prostate “seed” implants Temporary Dose Rate Source place within Breast, Prostate the tumor Contact Duration Interstitial Source implanted for a specific treatment duration Most brachytherapy treatments are temporary for a wide variety of cancers High 12 Gy/hour Breast, cervix, prostate, skin Medium 2–12 Gy/hour Cervix Low 0.4–2 Gy/hour Prostate, oral
  • 24. Radiation Sources
  • 25. • In brachytherapy, the radiation dose is applied to tumor by sealed sources. The sources are implanted to the tumor tissue itself or in its close vicinity. • They are enclosed in a protective capsule or wire which allows the ionizing radiation to escape to treat and kill surrounding tissue, but prevents the charge of radioisotope from moving or dissolving in body fluids. • Sources can be tubes, needles, wires, pellets or seeds.
  • 26. • Brachytherapy sources are usually encapsulated; the capsule serves several purposes: • Containing the radioactivity; • Providing source rigidity; • Absorbing any alpha and, for photon emitting sources, beta radiation produced through the source decay.
  • 27. • The choice of an appropriate photon emitting radionuclide for a specific brachytherapy treatment depends on several relevant physical and dosimetric characteristics, the most important of which are the:  Photon energies and photon beam penetration into tissue and the shielding materials;  Half-life;  Half-value layer (HVL) in shielding materials such as lead;  Specific activity;  Source strength;  Inverse square fall-off of dose with distance from the source (this is the dominant dosimetric effect, because of the very short treatment distances used in brachytherapy).
  • 28. Radionuclide Type Half-Life Energy Cesium-137 (137Cs) γ-ray 30.17 years 0.662 MeV Cobalt-60 (60Co) γ-rays 5.26 years 1.17, 1.33 MeV Iridium192 (192Ir) γ-rays 73.8 days 0.38 MeV (mean) Iodine-125 (125I) γ-rays 59.6 days 27.4, 31.4 and 35.5 keV Palladium103 (103Pd) γ-ray 17.0 days 21 keV (mean) β--particles 1.02 years 3.54 MeV Ruthenium106 (106Ru) Commonly used radiation sources (radionuclides) for brachytherapy
  • 29. CESIUM 137 • Symbol: (137Cs) • Half-Life: 30.17 years • Energy: 0.662 MeV • most widely used source for the treatment of gynecological cancer • distributed within an insoluble glass or ceramic matrix • encapsulated in stainless-steel sheaths with wall thicknesses of 0.5 to 1.0 mm, active lengths of 13.5 to 15 mm, diameters of 2.6 to 3.1 mm, and total lengths of about 20 mm.
  • 30. COBALT 60 • Symbol: (60Co) • Half-Life: 5.26 years • Energy: 1.17-1.33 MeV • In the form of wire which is encapsulated in a sheath of platinum, iridium or stainless steel. • available as pellets with a typical activity of 18.5 GBq (0.5 Ci) per pellet.
  • 31. IRIDIUM 192 • Symbol: (192Ir) • Half-Life: 30.17 years • Energy: 73.8 days • available in the form of seeds, 0.5 mm in diameter and 3 mm long, for LDR BT • Also used in the form of a wire (0.3-mm or 0.6-mm outer diameter) consisting of an iridium-platinum radioactive core encased in a 0.1-mm sheath of platinum.
  • 32. IODINE 125 • Symbol: (125I) • Half-Life: 59.6 days • Energy: 35.5 keV • Used for permanent implants • Only available as seeds. They are usually inserted into the tumour volume using special delivery ‘guns’.
  • 33. Source storage and handling Radioactive sources must be under the control of an appropriate person at all times…  Ordering  Receiving  Storage  Handling  Use  Disposal
  • 34. SOURCE STORAGE Source stores must:  provide protection against environmental conditions  be only for radioactive materials  provide sufficient shielding  be resistant to fire  be secure  be labelled
  • 35. ACCOUNTABILITY OF SOURCES Source accountancy records should contain: radionuclide and activity of sources location and description of sources disposal details The records should be updated regularly, and the location of the sources checked.
  • 36. FEATURES OF SOURCE STORAGE Secure (lock and key) Labels Different compartments Shielding Easy access Well organized
  • 37. TRANSFERRING SOURCES FROM AND INTO A SAFE Use of tweezers Behind shielding Short transport ways
  • 38. HANDLING OF SOURCES General:  avoid contamination  use gloves  no eating/drinking in room  use long forceps Let someone know if you work with radioactivity
  • 39. EQUIPMENTS
  • 40. AFTERLOADER MACHINE • A computerized medical device that drives a small radioactive source through catheters to predetermined dwell positions for a specific time in a patient's body during brachytherapy.
  • 41. APPLICATOR • A device used to hold a radioactive source in place during brachytherapy. • Applicators are non-radioactive and are typically needles or plastic catheters. The specific type of applicator used will depend on the type of cancer being treated and the characteristics of the target tumor.
  • 42. PROCEDURE
  • 43. Typical stages of a brachytherapy procedure.
  • 44. INITIAL PLANNING • In order to accurately plan the brachytherapy procedure, a thorough clinical examination is performed to understand the characteristics of the tumor. • A range of imaging modalities can be used to visualize the shape and size of the tumor and its relation to surrounding tissues and organs. • Data from many of these sources can be used to create a 3D visualization of the tumor and the surrounding tissues.
  • 45. • This initial planning helps to ensure that ‘cold spots’ (too little irradiation) and ‘hot spots’ (too much irradiation) are avoided during treatment, as these can respectively result in treatment failure and sideeffects.
  • 46. INSERTION AND IMAGING OF THE APPLICATOR(S) • Before radioactive sources can be delivered to the tumor site, the applicators have to be inserted and correctly positioned in line with the initial planning. • Imaging techniques, such as x-ray, fluoroscopy and ultrasound are typically used to help guide the placement of the applicators to their correct positions and to further refine the treatment plan. • CAT scans and MRI can also be used.
  • 47. • Once the applicators are inserted, they are held in place against the skin using sutures or adhesive tape to prevent them from moving. Once the applicators are confirmed as being in the correct position, further imaging can be performed to guide detailed treatment planning.
  • 48. CREATION OF A VIRTUAL PATIENT • The treatment planning software enables multiple 2D images of the treatment site to be translated into a 3D ‘virtual patient’, within which the position of the applicators can be defined. • The spatial relationships between the applicators, the treatment site and the surrounding healthy tissues within this ‘virtual patient’ are a copy of the relationships in the actual patient.
  • 49. TREATMENT DELIVERY • The sources used in Brachytherapy can be delivered manually, but are more commonly delivered through a technique known as ‘afterloading’. • Manual delivery of brachytherapy is limited to a few LDR applications, due to risk of radiation exposure to clinical staff • In contrast, afterloading involves the accurate positioning of non-radioactive applicators in the treatment site, which are subsequently loaded with the radiation sources. In manual afterloading, the source is delivered into the applicator by the operator
  • 50. • Once the applicators are correctly positioned in the patient, they are connected to an ‘afterloader’ machine (containing the radioactive sources) through a series of connecting guide tubes. • The treatment plan is sent to the afterloader, which then controls the delivery of the sources along the guide tubes into the pre-specified positions within the applicator. • This process is only engaged once staff are removed from the treatment room. • The sources remain in place for a pre-specified length of time, again following the treatment plan, following which they are returned along the tubes to the afterloader.
  • 51. PROSTATE • literally "one who stands before", "protector", "guardian“ • Tubuloalveolar exocrine gland of the male reproductive system in most mammals. • A walnut-sized gland located between the bladder and the penis
  • 52. • A healthy human prostate is classically said to be slightly larger than a walnut. • The mean weight of the normal prostate in adult males is about 11 grams, usually ranging between 7 and 16 grams. • It surrounds the urethra just below the urinary bladder and can be felt during a rectal exam. FUNCTION The function of the prostate is to secrete a slightly alkaline fluid, milky or white in appearance, that usually constitutes 50–75% of the volume of the semen along with spermatozoa and seminal vesicle fluid.
  • 53. DESCRIPTION • Brachytherapy takes 30 minutes or more, depending on the type of therapy you have. Before the procedure, you will be given medicine so that you do not feel pain. You may receive: • A sedative to make you drowsy and numbing medicine on your perineum. This is the area between the anus and rectum. • Anesthesia. With spinal anesthesia, you will be drowsy but awake, and numb below the waist. With general anesthesia, you will be asleep and pain-free.
  • 54. After you receive anesthesia: • The doctor places an ultrasound probe into your rectum to view the area. The probe is like a camera connected to a video monitor in the room. A catheter (tube) may be placed in your bladder to drain urine. • The doctor uses ultrasound or a CT scan to plan and then place the seeds that deliver radiation into your prostate. The seeds are placed with needles or special applicators through your perineum. • Placing the seeds may hurt a little (if you are awake).
  • 55. Types of brachytherapy • Low-dose radiation brachytherapy is the most common type of treatment. The seeds stay inside your prostate and put out a small amount of radiation for several months. You go about your normal routine with the seeds in place. • High-dose radiation brachytherapy lasts about 30 minutes. Your doctor inserts the radioactive material into the prostate. The doctor may use a computerized robot to do this. The radioactive material is removed right away after treatment.
  • 56. WHY THE PROCEDURE IS PERFORMED? • Brachytherapy is often used for men with a small prostate cancer that is found early and is slow-growing. Brachytherapy has fewer complications and side effects than standard radiation therapy. You will also need fewer visits with the doctor.
  • 57. BEFORE THE PROCEDURE Tell your doctor or nurse what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription. Before this procedure: • You may need to have ultrasounds, x-rays, or CT scans to prepare for the procedure. • Several days before the procedure, you may be told to stop taking medicines that make it hard for your blood to clot. These medicines include aspirin, ibuprofen (Advil), clopidogrel (Plavix), and warfarin (Coumadin). • Ask your doctor which medicines you should still take on the day of the surgery. • If you smoke, try to stop. Your doctor or nurse can help.
  • 58. ON THE DAY OF THE PROCEDURE: • You will likely be asked not to drink or eat anything for several hours before the procedure. • Take the medicines your doctor told you to take with a small sip of water. • Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.
  • 59. AFTER THE PROCEDURE • You may be sleepy and have mild pain and tenderness after the procedure. • After an outpatient procedure, you can go home as soon as the anesthesia wears off. In rare cases, you will need to spend 1 - 2 days in the hospital. If you stay in the hospital, your visitors will need to follow special radiation safety precautions. • If you have a permanent implant, your doctor may tell you to limit the amount of time you spend around children and women who are pregnant. After a few weeks to months, the radiation is gone and will not cause any harm. Because of this, there is no need to take out the seeds.